HomeMy WebLinkAboutDouglas - Permit Application.pdfAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
' 1, Ll LDii
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CBDG Funding
PERMIT APPLICATION FOR:
I PROPOSED IMPROVEMENT LOCATION:
Address: b385 GMZVENA sfggeT , F02T 'VILE. FL 3ci962
V
Property Tax ID #: 3LO 7 0 3. 601PS - 000 -6 Lot No. 25 3 Vo
Site Plan Name: 0'385 4ARMp1A yr"f"r Block No. t0
Project Name:
DETAILED DESCRIPTION OF WORK: I
W ITH 1.5" gTiM1bIN4 SEA*A 24 GA h1E--'fAl, V4CC19A SY5-r M
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing_ Sprinklers
Total Sq. Ft of Construction: Li -,III %G'a1FT
Cost of Construction: $ 30) I 1 3 ' 0y
(Affidavit required)
Shutters Windows/Doors Pond
_ Generator _RoofPitch
Sq. Ft. of First Floor: % 111 SQrT
In/
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name AIJIEIi rugI t As
Name: AURAW D,+melm RYGK-mAW
Address: OW GAUC-NA 5Terxr
Company:A1,►.lA'N0 CiTWP ca1J[RA Wir CXP
City: p",cE Stater_—
Zip Code: 34482 Fax:
Phone No. 772- 1- 97LID E-
Address: 05 IJW EN71EeMA E TV'tv+F
City: 1202T G'T WCA6 State: FL -
Zip Code: 31000 Fax:
Phone No 172-igg2-6W(O
Mail:( ayithtWiyldbWM(Ln1 @a0I-Com
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail Adaml cKmtan P Aw1d it -GOW1
State or County License CCC 133Ga18
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
u.Ath Icnrlair nr nn nttnrnpv hpfnrp rnmmpnrin¢ work or recordine vour Notice of Commencement.
Signatu of caner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
V1— �n
COUNTY OF I
J
Swor (or affir ed and subscribed before me of
thisitdayof,�J�,p,,►V9 by
Physical Presence or _ Online Notarization
�2,�0,I24
�Aj4JyM—1of_MA1,'
Name of person making statement.
Personally Known OR Produced Identification
Ty e I entifica iion�Pr duce -
(Signatur f Notary Public tate of Florida)
,y]�1�ju}'11�I�i2{/I��
�w.d ELIZABETH A. SCILER
Notary Public, State Of Florida
Commission No.11M41Ji- (Seal)
# *
�.o� Corrrmission No. IIH74732
My Commissmn Expires: 12/22/2024
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